Avoidant/Restrictive Food Intake Disorder (ARFID)

Avoidant/restrictive food intake disorder (ARFID) is a condition that causes one to limit the amount and type of food you eat. It is characterized by a persistent failure to meet appropriate nutritional and energy needs. Unlike other eating disorders, ARFID is not primarily associated with concerns about body weight or shape. Instead, individuals with ARFID may avoid certain foods due to core anxieties, sensory issues, a lack of interest in eating, or a fear of adverse consequences such as choking or vomiting.

ARFID can occur in children, adolescents and adults. It may be difficult to isolate as it often appears with concurrent disorders, such as anxiety and trauma. People with ARFID, particularly children and adolescents, suffer psychosocial issues, due to avoidance of public eating and fear of adverse consequences. Specialized treatment approaches, including Cognitive Behavioral Therapy for ARFID (CBT-AR), are necessary for successful treatment.

Avoiding foods can restrict a diet to a very limited range of foods. There are three different sub-types of ARFID; sensory sensitivity, fear of aversive consequences, and lack of interest in eating.  It is common that an individual with ARFID may suffer with more than one sub-type. Those with sensory sensitivity avoid certain foods due to specific sensory characteristics like texture, color, or smell.  Individuals who have a fear of aversive consequences, limit their food volume and variety due to concerns that they could choke or vomit.  Sometimes, this is experienced as a result of a traumatic experience.  Those with the lack of interest sub-type avoid eating often because they are not in touch with their hunger cues, may have difficulty switching tasks, and may find themselves realizing at the end of the day that they missed meals.  These avoidances can lead to significant nutritional deficiencies, weight loss, and interference with normal growth and development in children and adolescents. Social situations involving food can be highly distressing and thus avoided, leading to isolation and anxiety.

Individuals with ARFID will often eat the same food over and over to avoid other foods, which in turn results in new foods tasting different to their preference, thus further restricting their diet and increasing anxiety. They may also engage in mealtime ‘rituals’ that friends find odd, resulting in further isolation and anxiety, particularly in adolescents in a school environment.

Physically, ARFID can result in malnutrition, significant weight loss, and growth delays in children. Individuals with ARFID often experience co-occurring conditions including anxiety disorders, obsessive compulsive disorder, neurodevelopmental disorders, and trauma-related disorders, Psychologically, it can cause anxiety, social isolation, and interference with daily functioning. Some symptoms may include:

• Avoidance based on the sensory characteristics of different foods
• Fear of choking or vomiting
• Lack of interest in eating
• Avoidance of social situations involving food
• Weight loss or lack of expected weight gain
• Mealtime rituals or routines
• Gastrointestinal issues
• Emotional distress

Prevalence of ARFID

While there is limited research on the prevalence of ARFID, studies have found that between 0.5%-5% of children and adults in the general population have the disorder. It often begins in childhood and can persist into adulthood if not properly addressed.

Therapy attempts to address the underlying fears and anxieties associated with food intake. Part of the process uses exposure therapy, which helps individuals gradually become more comfortable with a variety of foods. Nutritional counseling ensures that dietary needs are met, and medical monitoring may be used to address any physical health concerns. Family-based therapy may also be beneficial, especially for younger patients, to support and educate family members.

Her are some of the goals of CBT-AR:

• Addressing core fears
• Achieve or maintain a healthy weight
• Increase variety to include multiple foods from each food group
• Reduce psychosocial impairment
• Feel more comfortable eating in social situations
• Psychoeducation about how avoidance maintains anxiety

Supporting someone with ARFID can be a difficult process requiring patience and concerted effort for the whole family. Proper treatment can lead to an expanded diet that supports proper weight and nutrition, decrease avoidance of foods and increase participation in social situations and more meaningful relationships.

National Eating Disorders Association (NEDA): Provides information, support, and resources for those affected by eating disorders, including ARFID.
NEDA

ARFID Awareness: A dedicated platform offering educational resources and support networks for individuals and families dealing with ARFID.
ARFID Awareness

Feeding Matters: An organization focused on pediatric feeding disorders, providing resources and advocacy for ARFID and other related conditions.
Feeding Matters

Academy for Eating Disorders (AED): Offers professional resources, research, and guidelines on the treatment of various eating disorders, including ARFID.
AED